A contemporary approach in homoeopathy, termed ‘Synergy’, has evolved over the last thirty years and is advantageous when utilized in homoeopathic practice. It is overall a clinically successful method. While utilizing the indepth knowledge of the fundamental and traditional tools of homoeopathy like Materia Medica, the Repertory, and the Organon, the Synergy method also values the newer approaches like Sensation, Kingdom, Miasm and Source understanding.
This is a unique system. Its’ design can be taught, practiced, and replicated successfully by students and practitioners alike. This method has established a universal platform where all approaches in homoeopathy are welcomed and used to aid in the patient’s recovery.
The triangle figure represents the Synergy concept in homoeopathy.
The peak of the triangle is the Genius as coined by Dr. C.M. Boger. In the foreword to his ‘Synoptic Key’ he states –“The strain which runs through every pathogenetic symptom complex has been called the genius of the drug”.The Genius has also been called by various authors in homoeopathy; the essence, keynote, soul, red line, or the grand general.
The sides of the triangle, Symptoms and System, complement each other, and when they are used together the best results ensue. Symptoms include the use of rubrics, structured repertorisation, keynotes, provings, characteristics, and clinical symptoms. The System includes kingdom, sensation and miasm.
The Anchor is a tool utilized along side the Synergy Triangle and emphasizes the application of complete symptoms (location, sensation, modality, concomitant) along with the clear, sure, definite, symptoms to create a reliable repertorisation graph, which is free of interpretation or bias.
When utilizing the idea of “Synergy”, all three sides of the triangle (Genius, Symptom and System) plus the use of the Anchor tool, must be included in the prescription, and ultimately each one will reach the same conclusion and remedy that matches the patient.
When trying to understand a patient there must be a solid grasp of the area that is most obvious in that case. It may be the Genius, the Symptoms, the System or the Anchor. By following this clear and definite lead, the other areas will also become evident. It is important to note that in cases sometimes the Symptoms are clear, or the Genius is clear, or the System is clear – however, in order for a successful prescription, all must be reconstructed and utilized in the same way.
Case of Bronchial Asthma and Urticaria
[This case transcript has been summarized for publishing purposes; D = Doctor, P = Patient]
Patient Details: Female, age 40
D: Tell me please, what is the problem?
P: It started with the throat 3-4 years back. I had an infection in my throat, continuous since then, and discharge comes from my left nostril. Last year in July I had a bronchitis attack. Now I have this urticarial thing, which has started, small red patches. It goes to the full body, and I get full body itching.
The congestion has been there for 3-4 years and these red patches start in the evening and increases in the night, but it decreases after bath. If the rashes go, then the breathing problem starts. If rashes go then breathing starts, that’s what I have observed.
What one has to look for from this point is for characteristic symptoms. Her most important and main characteristic from this dialogue would have to be her symptom of urticaria alternating with breathing problems and asthma. We can look in the repertory in the chapter Skin to find a matching rubric. In the repertory, the following rubric is a summary of this symptom, SKIN; ERUPTIONS; urticaria alternating with asthma.
This is a characteristic and sure symptom, one that is not left for interpretation and is very clear. When we look at this rubric, we see that there are only four remedies – apis., calad., crot-tig. and graph. This is her main symptom and it is very characteristic so if we can find a remedy that has this symptom, then there can be surety. Of course, since this rubric has only four remedies, one must look elsewhere in the repertory to find a better representation.
We can also investigate other similar rubrics such as RESPIRATION; Asthmatic alternating with eruptions. Again, we have remedies like apis., graph., crot-tig, and calad. in this rubric. Either rubric we decide to select will represent the strange, rare and very characteristic symptom in this patient.
This symptom can be our first symptom in the Symptom part of the Synergy triangle. We can also consider this as the Genius of the patient –thus, we have to find a remedy that has this exact symptom as its main idea and match it with the patient.
D: When the rashes come the breathing gets better?
D: Are there any other complaints?
P: I cannot sit in an air-conditioned room, and I work in an office with AC. I get suffocated with more discharge. My nose runs from the air-conditioned air, and the discharge is thick. It is not yellow, but not runny, it is transparent. I also got worse after I moved from Goa to Mumbai.
The second very strong symptom in her case is her aggravation by change of weather – particularly the aggravation in damp weather. The patient had moved from Goa to Delhi (both dry places) to Mumbai, where the weather is damp. In this dampness her symptoms aggravate, like her nasal discharge and pains.
For this symptom we can look in the repertory in the Generals chapter. We can look at the rubric GENERALITIES; WEATHER; damp weather agg.
This second rubric can also be used to contribute to the Symptom part of the triangle.
D: What dreams do you get?
P: Earlier I used to have dreams of small babies. I am fond of sleeping and eating, if I am hungry I become restless. I sleep soundly. I get restless, so I have to eat. Even my husband says I like to eat and that I like to sleep. I always have to call my husband if I am feeling anxiety or tension. I need to talk to him when I feel this way – and I feel better when I talk to him.
The third most interesting thing in the case comes from her description of herself that is confirmed by her husband. The patient says she likes to sleep and eat – the husband agrees. This is representative of the phase in life where the patient is – she is like a baby, she likes to sleep and eat and she is very dependent on her husband. She said that she only likes to talk to him and said that he is the only one who does everything for her, so there is a very strong dependence seen.
This symptom fits into the System part of the Synergy triangle – it is more based on kingdom. Here, we see that the mineral kingdom is well represented – she is very dependent on her husband for everything, and it is evident that although she is an adult, she is stuck at a very early developmental stage (baby-like).
D: Exams meaning…what are you feeling?
P: I used to get cold palms, and little bit sweat. I cannot sit idle, I am always doing something and so I always keep busy. I always want to do these things because I become very restless. Some fear is there, that if I sit and don’t update myself, then everybody will go ahead, and they will do better than me.
Also note that in the case there is an apparent kind of restlessness. She cannot sit in one place, she must move. There is a rubric in the repertory in the mind section that represents her restlessness: MIND; FIDGETY; she must be occupied, cannot sit in one place. We can also look at the rubric, MIND; FIDGETY; work at.
This is an important mind symptom which we can take as part of the Symptom part of the triangle.
D: If you don’t update yourself, then what will you feel in this situation?
P: Depressed and wanting to cry. If I am busy then I am ok. When I leave the office and am alone, I call my husband. Until I do this, I don’t feel better. I need someone to share my feelings with during that time. I feel better when I cry and when I tell my husband.
D: What are the things that make you very tensed or nervous?
P: Speaking in public makes me nervous a little. If the person I don’t like comes in contact with me I get tense.
D: What is the fear of at that time?
P: The fear is that they will hurt me basically. I won’t feel comfortable with that person, that environment. I am in tension. When I am alone this happens. I want to be busy, and I want to divert my mind.
D: Tell me about this, I want to be busy?
P: When I am not busy I think about negative things I don’t like. I get tension, I don’t feel nice, and so I call my husband and mother for emotional support.
D: What is emotional support?
P: Emotional support means they will usually give suggestions. They console me and I want to be consoled. They tell me that you can study something, even though I know this too but I need to be consoled. I feel, good that somebody is there, and I am not alone. It’s a good support.
Again, we see here her main modalities include being ameliorated by support and consolation, in addition to amelioration from expressing herself.
We also notice that she re-iterates her desire to keep busy or diverted and from this we can conclude that this restlessness comes in more than one area in the case and can be taken in the repertorisation.
D: What are your interests and hobbies?
P: Before I used to play table tennis, badminton, even running. In childhood I used to do physical activity more, in 11th grade I wanted to go to join the army because I was tom boyish, so I wanted to be an officer. I see mom making chappati (an Indian bread), and so I told my mom I don’t want to make chappati. I feel girls can do everything. I feel confident and the opposite is feeling down low, depressed and low key.
What is also interesting is that there are two sides of this patient. One is a fantasy side, the girl who is able to do everything, a girl who can go out, a girl who can be in an army. This is her fantasy and the opposite of that is what she really is. She is very under confident, always needing somebody, and wanting support. This is her inner state but her fantasy is being in the army.
When we examine the System part of the triangle in this case when we see the exact opposite of her fantasy, we understand there are many carbon symptoms.
Carbon symptoms include the startling from noise, startling when waken from sleep, the suffocation inside the closed room and desire for open air. We also see an affinity for the skin in this area.
These are also specific symptoms of the remedy graphites, which is apart of the Carbon group of remedies.
The patient was a female of age 40. However, what was most characteristic was that she brought her husband with her into the consultation room. She would want to make him say everything and would probe her husband to say more. Halfway through the case taking I even tried to stop him from talking, but she kept on encouraging him to talk about her. In my understanding, this in itself is very strange – she is quite old for doing this and it shows her obvious dependency on her husband. Further in the case, the patient mentioned she has cracks in her feet, is sensitive to sudden sound, and likes the windows open otherwise she feels suffocated.
In this case, all of the symptoms that were established were sure, clear and exact. Most importantly, they were characteristic to the patient – which meant we had to have a remedy that matched these characteristics.
If we examine the Symptoms of the case we see that there are characteristic general, particular, physical and mind symptoms that can be reproduced in the form of rubrics from the repertory. The Anchor is clearly depicted in this remedy.
The first solid symptom and Anchor in the case can be represented by a single rubric:
- SKIN; ERUPTIONS; urticaria, nettle-rash alternating with, asthma
However, since this rubric is fairly small, we can look at a more general rubric:
- RESPIRATION; ALTERNATING states; eruptions
The Anchor in this case is not prejudiced. It is a clear, solid and sure symptom that is characteristic to the patient. One can use it as an entry point to the case. Once we establish the Anchor in the case we can look at the remedies that have these characteristic symptoms. However, it is always important to remember not to be stuck on a rubric, keynote, kingdom, or miasm indicator – be flexible in your approach.
When understanding the System side of the triangle, one should consider the following characteristics:
Type of Nature
When we look at the System side of the triangle, we observe who this person is. A few characteristic observations of her to note include:
- The way she came in and she let her husband talk about her
- Husband says she likes to eat, she likes to sleep (and she agrees)
- Who likes to eat and sleep and then she is very dependent on him – he says that she likes to just sleep and eat, and if she becomes hungry, she gets restless
- Main modalities also better by support, better by expressing herself
What we can conclude from these observations is that the patient is:
- Just eats and sleeps
- Needs support for everything
- Irresolute for everything
- Emotional support
In the repertory, this mental picture can be represented by the following rubrics:
- MIND; CLINGING
- MIND; RESTLESSNESS, nervousness; sitting while
Which Kingdom does this lead us to?
These characteristics about the patient lead us to the Mineral Kingdom. She is dependent, naïve, just eats and sleeps, needs support for everything, and needs emotional support.
In Row 3 of the Periodic Table, the main issues are identity, care and nourishment.
From the System point of view we can see the kingdom and row quite clearly. When we look at the particular themes of the Carbon family, we see themes of dependency, wanting and valuing the opinions of others, a sense of childishness and smallness, irresolution, and skin problems. These people do not want to enter the world. They want to find a way to escape from their environment because it is difficult to cope. There is a great dependency and desire for support.
Carbon remedies also have the matching symptoms of:
- Starting from noise
- Starting from waking from sleep
- Suffocation in closed room
- Desire for open room
This patient dreams of babies and children. We can look at the direct rubric:
- DREAMS; child, children; babies
Final Repertorization Graph
Graphites is a fundamental carbon remedy. The keynote symptom in Graphites is irresolution. They will ask others opinions before acting. In this case, the patient depended heavily on her husband for support. These patients also cannot deal with a crisis or new situation and often develop tremendous anxiety and panic attacks.
Follow-Up after 10 months:
D: How are you doing?
P: I am much, much better than I was since the first time I came in September but the same congestion is there. My throat is better than before. The only thing was that the feeling was there that it will happen but no it did not happen. It isn’t acute, and the frequency is also reduced. Sleep is good now. Energy wise I am also much better. Emotions wise I am also much, much better now. I am not feeling discomfort and now I am also busy with my work.
Now I can manage. I feel, now I can manage so I am managing actually. I even am not tensed about issues in my family. There is also no fear actually. Only when the family comes who I don’t know I get a little fear. I get a fear like something will happen. So now, there is no fear so I am okay. Eventually they will come, so I don’t know. Maybe I will feel much better. Anxiety levels are better than before, so much better. Overall, I say I am 80% better.
I believe that most cases can be done in 15-20 minutes. This is because the obvious thing, the most central thing in the case should be found and investigated. If you have to search and search in a case, then it is not a central focus!
My advice is to use the old and new approaches together – use both System and Symptom. The System will give you the crux and the Symptom(s) will give you the hard facts, the inarguable data. Suppose you come through rubrics and repertorising to find the remedy, you then have to see if the sensation and the experience also matches.
Further explanation with cases illustrating this idea can be found in my latest book: The Synergy in Homoeopathy, published by Homoeopathic Medical Publishers (www.rajansankaran.com). I also strongly recommend learning to use this approach through observation of good practitioners taking cases. This is possible at the other song academy in Mumbai, India.
Source: The Homoeopathic Heritage, August 2013